The invention relates to apparatus and methods for medical treatment. It has application, by way of non-limiting example, in the delivery of dialysis care in the home.
Dialysis is an important treatment regimen for a variety of chronic diseases. To meet the need for regular care, patients typically travel to hospitals or dialysis centers that are designed for efficient and routine therapy. Typically, a nurse or patient care technician oversees the treatment sessions and records patient information, such as patient vitals, treatment details, and billing information. The nurse or care technician can also assess the patient's health and, if necessary, make a referral to his or her regular physician (or, if necessary, to an emergency physician) for additional medical attention.
With the advent of more affordable equipment, home dialysis is increasingly an option for many dialysis patients, who find it offers them greater privacy, flexibility of scheduling and overall comfort. Home provision of hemodialysis can also be advantageous to health care providers since it does not require the nursing, equipment and space overhead of standard in-center care. Medicare/Medicaid and other insurers stand to benefit, too, since home hemodialysis tends to lower coverage costs over the long term.
The decision to place a patient on home hemodialysis (HHD) is not necessarily an easy one, however. The demands of a hemodialysis regime, even one administered in the home, are such that HHD programs suffer a high dropout rate as patients revert to in-center dialysis. These dropouts are not necessarily for medical reasons but, rather, are often due to the mental and/or physical demands HHD care places on patients and their partners. Considering the costs of providing patient training, the expenses of adjustment of the infrastructure at the patient's home, cost for installation of the equipment and delivery charges, patients that drop out of HHD programs create an economic burden on the health care system.
Even for those patients on a course of HHD therapy, full compliance with the regimen can be difficult. This is true, for example, with respect to administration of medications taken as part of the regimen. Erythropoietin, a drug commonly administered to hemodialysis patients to prevent anemia, is one example. Dosages of this expensive drug can be reduced, if it administered subcutaneously. That can be more painful, however, leading HHD patients to skip doses. This not only adversely affects treatment outcome but may raise the specter of insurance fraud—since, unless the patients admit they are under-dosing, care providers are likely to dispense and seek reimbursement for monthly complements of EPO, regardless of whether patients have used them.
An additional consideration in the decision to place a patient on HHD is that of patient monitoring. HHD therapy affords fewer opportunities to assess patient health, well-being and treatment compliance. Care givers typically have that opportunity only when HHD patients visit their local dialysis clinic for monthly evaluation—and, then, only to the extent that the success of treatment can be determined from routine testing and from patient reporting. Significantly, although HHD equipment may record limited patient information (such as date/time of treatment, blood pressure and pulse), it does not afford the care giver insight into adverse events that occur during actual HHD treatment sessions, such as dizziness, vomiting and cramps. Moreover, while the prior art does suggest that there has been some effort to collect in a central databases even the limited patient data acquired by HHD equipment, this has not been perceived by care providers as a suitable substitute for in-center visits.
In view of the foregoing an object of the invention is to provide improved medical care systems and methods. A more particular object is to provide such systems and methods as are adapted for patient treatment and monitoring.
A further object of the invention is to provide such systems and methods as are adapted for use in home (or other remote) health delivery.
A still further object of the invention is to provide such systems and methods as are adapted for use in hemodialysis and peritoneal dialysis treatment.